Cost and Quality Comparison of Hernia Surgery in Stationary, Day-Patient and Outpatient Care

Round 1

Reviewer 1 Report

There is a great deal of interest worldwide in improving the cost of medical treatment.

In addition, cost comparisons among different treatment methods need to be economically discussed from the viewpoint of efficiency improvement.

Therefore, we believe that this paper is very significant.

Overall, the analytical methods and interpretation of the results have been brushed up, and I do not see any major problems.

However, I have the impression that the revenue and profit/loss are described in a mixed manner.

For this reason, if possible, I would like the authors to consider a description method that is easier for readers to understand, such as "profit (profit/loss)". I think this will help readers' understanding more.

It would be an excellent study if the results of this paper could suggest the patient profile (age, medical history, etc.) from which each treatment method should be selected or recommended.

Please consider it.

Author Response

Reviewer 1:

1. There is a great deal of interest worldwide in improving the cost of medical treatment. In addition, cost comparisons among different treatment methods need to be economically discussed from the viewpoint of efficiency improvement. Therefore, we believe that this paper is very significant. Overall, the analytical methods and interpretation of the results have been brushed up, and I do not see any major problems.

However, I have the impression that the revenue and profit/loss are described in a mixed manner.

For this reason, if possible, I would like the authors to consider a description method that is easier for readers to understand, such as "profit (profit/loss)". I think this will help readers' understanding more.

 Answer: We thank the Reviewer for this important comment. To clearify we added following description in to the methods section

We were able to obtaine data from the controlling department’s internal data processing system and correlated these with the definitive contribution margin (CM) of individual procedures. The CM value indicates a possible over or under-coverage relating to case-specific costs and is referred to hereinafter as final revenue. To achieve the base price of a DRG case-based lump sum we multiplied the respective evaluation ratio by the base case rate.

We hope this clarification is in line with Reviewer 1 suggestions.

2. It would be an excellent study if the results of this paper could suggest the patient profile (age, medical history

Answer: We thank the Reviewer for this important comment. To clearify we added following description in to the Discussion:

In general, outpatient treatment is feasible for any patient regardless of gender or age. However, the following patient-specific factors make inpatient treatment necessary. Expected intensive care follow-up. Nontemporarily substitutable blood disorders, oral anticoagulation, coagulopathy relevant to surgery and use of drainage tubes. Comorbidities such as significantly pathologic pulmonary parameters, known severe obstructive sleep apnea disease, angina pectoris grade III or IV (CCS), heart failure NYHA III or higher. Malignant hypertermia in self history or family history, obesity WHO grade III or other severe unstable diseases. Social factors due to which immediate medical care of the patient would not be possible such as, Lack of communication facility, no transportation facility to or poor accessibility of medical care Lack of patient's ability to understand, lack of care facility by person ın the first 24 hours after surgery. These factors correspond to the rules which apply to the inpatient treatment of a patient with elective inguinal hernia care in our hospital. Emergencies are always treated as inpatients. These factors are often but not always associated with older age.

We thank for the helpful comments and hope that our changes fullfil the reviewer requests.

 With kind regards

Reviewer 2 Report

This paper describes an interesting study about Cost and Quality comparison of hernia surgery in stationary. however, I consider the study methodology appears to be reasonably sound, but there is a general lack of clarity/lack of detail in the paper, so it is difficult to judge its merits. 

consider adding the following:

Consider reporting details sample size calculation.

What statistical software was used to analyze data?

ethics committee reggister

Author Response

Reviewer 2

1. This paper describes an interesting study about Cost and Quality comparison of hernia surgery in stationary. however, I consider the study methodology appears to be reasonably sound, but there is a general lack of clarity/lack of detail in the paper, so it is difficult to judge its merits. 

consider adding the following:

Consider reporting details sample size calculation.

Answer: we have all patients operated between January 2019 and December 2021, no patient is excluded except little one 18 years old

2. What statistical software was used to analyze data?

We thank the Reviewer for this Question. In Section 2.2 statistical analysis we state:

analyzes were carried out in the R computing environment version 4.1.2 (25). Interaction diagrams and simple slopes (26) were computed with the R package interactions (27).

ethics committee reggister

We thank the Reviewer for this Question. The Manuscript contains the official Ethiccommitee number Req-2021-00420 Zurich/Switzerland as followed:

Institutional Review Board Statement: Ethical review and approval were waived for this study, according to the consultation with the Local Ethical Committee (Req-2021-00420).

We thank for the helpful comments and hope that our changes fullfil the reviewer requests.

With kind regards